Pathophysiology and Pharmacology in COPD – A case report

Background to Clinical Scenario: Robert is a 51 year old man who lives with his wife in regional Victoria. He has been admitted to your ward from the Intensive Care Unit (ICU), where he had a 3 day stay for an acute exacerbation of COPD, caused by community acquired pneumonia. He required several days of non-invasive ventilation whilst in ICU. Robert tells you his wife (Jill) was very frightened when he was admitted to ICU, and he doesn’t want ‘to put her through that anymore’. He would like some help to understand and manage his COPD. Robert said he was diagnosed with COPD about 18 months ago by his GP, but admits he was sick for ‘a while’ before that. He is a current smoker, and has smoked for about 40 years. He has unsuccessfully attempted to quit on more than 5 occasions. Robert worked for many years on his chicken farm, but now finds he becomes breathless very easily and Robert and Jill have had to hire a farm helper. Robert’s medications include:

Salbutamol 2 – 4 puffs PRN

Budesonide/Efomoterol fumarate dehydrate 2 puffs daily

Metoprolol 25mg daily

Aspirin SR 100 mg daily
Pathophysiology 1.1: Describe the pathophysiology of COPD. Include in your answer the two disease processes contained in the umbrella term ‘ COPD’ and how they develop.
Robert has been diagnosed with a severe exacerbation of COPD, caused by Community-Acquired Pneumonia.
1.2 Explain the term ‘acute exacerbation of COPD’. What factors put patients like Robert at high risk for exacerbations of COPD? What else may contribute to an exacerbation of COPD?

1.3 Describe the pathophysiology of pneumonia
Include in your answer the differences between Community Acquired, Hospital Acquired and Health Care Associated Pneumonia.

Pharmacology: The Respiratory Physician who reviewed Robert in ICU suggested some changes to his current inhaler regime. The physician suggested that Robert cease his Budesonide/Efomoterol fumarate dehydrate, and commence on Tiotropium 2 puffs daily.

2.1 For each of the three inhalers (Salbutamol, Budesonide/Efomoterol fumarate dehydrate and Tiotropium), describe the Mechanism of action in COPD Contraindications and Adverse Reactions Nursing Considerations and Patient Education Points Include in your answer why the respiratory physician might have changed Robert’s medication regime.

CRICOS Provider No. 00103D NURBN 2012 Semester 1, 2018 Clinical Scenario Assignment Page 3 of 3
Robert was diagnosed with Community-Acquired Pneumonia, and Streptococcus pneumoniae was cultured from his sputum.

2.2 Identify three antibiotics that could be used to treat Streptococcus pneumoniae in Robert’s case. For each antibiotic, describe the Mechanism of action Contraindications and Adverse Reactions Nursing Considerations and Patient Education Points
Psychosocial issues 3.1 Discuss three evidence-based interventions to help Robert manage his COPD.

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